Association of children's oral health and school environment on academic performance in 12-year-old schoolchildren of Quito, Ecuador

OBJECTIVES

The primary aim of this study was to evaluate if children's oral health and oral health-related quality of life (OHRQoL) were associated with school performance. Moreover, the study aimed to examine whether school environment factors influenced this association.

METHODS

This cross-sectional study was based on a population-based sample of 998 12-year-old schoolchildren from 31 public schools in Quito, Ecuador. Trained and calibrated examiners conducted clinical exams for dental caries, dental trauma and malocclusion. Furthermore, children completed the Spanish version of the Child Perception Questionnaire (CPQ11-14 ), and their parents answered questions about socio-economic status. School coordinators provided information on the physical environment, promotion of health practices and the occurrence of negative episodes in the school. There were three outcomes: grades obtained in Spanish language and mathematics and the number of missed school days. Multilevel linear and Poisson regression models were conducted using a hierarchical approach to include the variables guided by a previously created direct acyclic graph.

RESULTS

Children with dental trauma and higher CPQ11-14 scores showed lower grades and school attendance. Schoolchildren from schools with episodes of vandalism had more school days missed.

CONCLUSION

The school performance of 12-year-old children is affected by dental trauma and by a worse OHRQoL, as well as a negative school environment. Therefore, supportive environments and promoting health measures in schools could overcome this worse academic performance in children with oral health problems.

The identification environment matters: Students' social identification, perceived physical school environment, and anxiety - A cross-level interaction model

The social identity approach to health argues that well-being depends on the psychosocial circumstances of the groups to which individuals belong. However, little is known about how the average level of identification in the group - 'the identification environment' - buffers the negative health consequences of stressors. We used multilevel modelling to investigate whether identification environment in a school modified the association between the students' perceptions of the quality of their school's physical environment and their reported levels of anxiety. In two representative samples of Finnish school students (N = 678 schools/71,392 students; N = 704 schools/85,989 students), weak identification environment was related to increased anxiety. In addition, in schools where identification environment was weaker, the student level relationship between perceived physical environment and anxiety was stronger, and students were more anxious. Our results provide evidence that identification environment needs to be considered when we analyse how group membership affects well-being.

Burnout among high school students is linked to their telomere length and relatedness with peers

School burnout is a serious concern, as it impairs students' health and academic success. According to the Conservation of Resources Theory, burnout results from the depletion of personal coping resources and can be counteracted by supportive social relationships. However, it is not yet clear how students' relatedness with their peers is linked to their burnout. Next to students' self-reported fatigue, biomarkers such as telomere length (TL), which presents an indicator of aging, complement stress research. To identify school-related factors that may prevent students from experiencing burnout and to link TL to students' self-reported burnout, the current study investigated how relatedness with peers as well as TL at the beginning of the school year explained students' burnout at the end of the school year. The sample included 78 students (Mage = 13.7 ± 0.7 years; 48% girls). Results of multilevel analysis in Mplus indicate that, over the school year, students with higher TL and those who experienced relatedness with their peers reported lower levels of burnout. Moreover, students who felt related to their peers exhibited a longer TL. The study implies that students' relatedness with their peers may be a promising setscrew to prevent students' burnout and support their physical health. This is one of the first studies to link TL with school-related variables such as burnout and relatedness to peers in a non-clinical student sample, providing a baseline for interventions and future interdisciplinary studies in the field of education and stress.

Investigating Individual Variation Using Dynamic Structural Equation Modeling: A Tutorial with Tinnitus

A growing body of research suggests that standard group-based models might provide little insight regarding individuals. In the current study, we sought to compare group-based and individual predictors of bothersome tinnitus, illustrating how researchers can use dynamic structural equation modeling (DSEM) for intensive longitudinal data to examine whether findings from analyses of the group apply to individuals. A total of 43 subjects with bothersome tinnitus responded to up to 200 surveys each. In multi-level DSEM models, survey items loaded on three factors (tinnitus bother, cognitive symptoms, and anxiety) and results indicated a reciprocal relationship between tinnitus bother and anxiety. In fully idiographic models, the three-factor model fit poorly for two individuals, and the multilevel model did not generalize to most individuals, possibly due to limited power. Research examining heterogeneous conditions such as tinnitus bother may benefit from methods such as DSEM that allow researchers to model dynamic relationships.

The impact of stress, recovery and coping on burnout symptoms of young elite table-tennis players: A prospective multilevel study

Objective

The aim of the present study was to explore the role of stress, recovery, and coping on table-tennis athlete burnout symptoms in considering both the roles of individual and contextual (training center) factors.

Methods

One hundred and fifty-nine youth elite table-tennis players (Mage = 14.07, SD = 2.13) involved in 15 intensive training centers completed self-report questionnaires and socio-demographic data.

Results

When time 1 (T1) levels 1 (individual) and 2 (training group, contextual factor) stress, recovery, and coping were simultaneously entered as predictors of each of the three burnout symptoms (physical and emotional exhaustion, sport devaluation, reduced accomplishment) at T2 (controlling for levels 1 and 2 burnout at T1), the results of multilevel analyses revealed that: (a) T1 level 1 recovery significantly negatively predicted T2 reduced accomplishment (β = -0.23, p = 0.03); (b) T1 level 2 disengagement-oriented coping significantly negatively predicted T2 reduced accomplishment (β = -0.71, p = 0.03); and (c) T1 level 2 task-oriented coping marginally significantly positively predicted T2 physical and emotional exhaustion (β = 0.99, p = 0.06).

Conclusion

Results of the present study provided evidence for the usefulness to disentangle the variances attributable to the individual (level 1) and contextual (level 2; training group) levels of the predictors (recovery, stress and coping) of athlete burnout. Moreover, rather than examining the antecedent role of stress on athlete burnout, it could be particularly fruitful to explore theoretical constructs able to annihilate the maladaptive effects of chronic stress such as coping and recovery.

The medicalisation of female genital cutting: Harm reduction or social norm?

Today, female genital cutting is increasingly practised by trained healthcare providers. While opposition to medicalised female genital cutting (FGC) is strong, little is known about the underlying motivation for this medicalisation trend in practising communities. We formulated three hypotheses based on medicalisation theories. The medicalisation of FGC: (i) is stratified and functions as a status symbol, (ii) functions as a harm-reduction strategy to conform to social norms while reducing health risks and (iii) functions as a social norm itself. Conducting multilevel multinomial regressions using the 2005, 2008 and 2014 waves of the Egyptian Demographic Health Survey, we examined the relationship between the mother's social position, the normative context in which she lives and her decision to medicalise her daughter's cut, compared to the choice of a traditional or no cut. We found that an individual woman's social position, as well as the FGC prevalence and percentage of medicalisation at the governorate level, was associated with a mother's choice to medicalise her daughter's cut. Further research on factors involved in decision-making on the medicalisation of FGC is recommended, as an in-depth understanding of why the decision is made to medicalise the FGC procedure is relevant to both the scientific field and the broader policy debate.

Multilevel analysis: Integrating multiple levels of neurobehavioral systems

Traditional disciplines have frequently dealt with complex phenomena from a given level of analysis, be that molecular, cellular, organ system, or organismic level. This can yield highly valuable information on biological and psychological processes. There is an explanatory value added, however, by an integrative multilevel approach, in which different levels of analysis and different levels of the neural organization are considered in the models and theories of psychological functions. This is the essence of the emerging discipline of social neuroscience, promoted by John Cacioppo and Gary Berntson, which seeks to inform the interactions between social psychological and biological processes.

Home-Based Telework and Presenteeism Across Europe

OBJECTIVE

Flexible work arrangements such as telework are gaining importance. Although telework is accompanied by advantages for employees such as increased flexibility, current research reveals associations between home-based telework and self-endangering behavior such as sickness presenteeism. As empirical evidence is still scarce, we explore the relationship between home-based telework and sickness presenteeism across Europe.

METHODS

We perform multilevel analyses including 25,465 individuals who responded to the 6th wave of the European Working Conditions Survey 2015.

RESULTS

Home-based telework is positively related to sickness presenteeism. The results are quite robust across different measures of sickness presenteeism and to several sensitivity analyses.

CONCLUSION

Although sickness presenteeism can be functional for specific illnesses, organizations should be aware of possible risks related to home-based telework. They should design telework in a way that it reduces triggers for self-endangering behavior.

Influence of school environment on occurrence of traumatic dental injuries in 12 years old children

BACKGROUND/AIM

Since children spend most of their time in school, some environmental characteristics of the schools may influence the occurrence of traumatic dental injuries (TDI). Therefore, the aim of this cross-sectional study was to assess the prevalence of TDI in 12 years old children in Quito, Ecuador, and its association with some school environmental aspects.

MATERIAL AND METHODS

Six calibrated examiners evaluated 998 children from 31 public schools of Quito, to evaluate the occurrence of TDI in anterior teeth. School coordinators answered questionnaires on school physical conditions, promotion of health practices and the occurrence of negative episodes in school. The occlusion and socioeconomic status of the participants were also evaluated. Prevalence of TDI, unadjusted and adjusted by the design effect was calculated. Association between individual and contextual explanatory variables and presence of TDI were evaluated using multilevel Poisson regression analysis (P < .05).

RESULTS

TDI prevalence adjusted by design effect was 20.7%. Children studying in schools with patio floor of grass and with access ramps had significantly lower prevalence of TDI than children studying in schools with patio floor of cement and with only stairs, respectively. The prevalence of TDI was also lower in children from schools that offered healthy meals or that had a proper place for oral hygiene.

CONCLUSIONS

Schools with adequate physical structures and that promote health practices to their students have a lower prevalence of TDI.

Psychological distress after the Great East Japan Earthquake: two multilevel 6-year prospective analyses

BACKGROUND

The Great East Japan Earthquake of 11 March 2011 led to the relocation of 300 000 survivors. Studies following disasters focus primarily on data collected in the immediate aftermath and neglect the influence of wider community factors.

AIMS

A three-level prospective study examining associations between survivors' psychological distress and individual- and social-level factors in the 6 years following a complex disaster.

METHOD

We drew on two multi-wave data collections in the 6 years after the earthquake, using residents from different forms of housing. Sample 1 included six waves of private-housing residents from 2011 to 2016 (n = 1084 per wave), sample 2 five waves of residents living in prefabricated housing from 2012 to 2016 (n = 1515 per wave). We analysed prospective associations between distress and time (level 1), pre-existing disorders and disaster experiences and behaviours (level 2) and city-wide measures of support and physical activity (level 3).

RESULTS

Multilevel models with random coefficients demonstrated greater distress in earlier waves (samples 1 and 2 respectively, adjusted β = -15 and β = -0.16, P < 0.001), among female respondents (β = 0.58, P = 0.01 and β = 1.74, P = 0.001), in those with a previous psychiatric history (β = 2.76, β = 2.06, P < 0.001) with diminished levels of activity post-earthquake (β = 1.40, β = 1.51, P < 0.001) and those lacking in social support (β = 1.95, β = 1.51, P < 0.001). Support from spouses and friends was most protective of psychological health. City-level support was negatively associated with distress, but only among those in prefabricated housing.

CONCLUSIONS

Psychological distress diminished with time, but varied across gender, psychiatric history, housing, levels of activity and availability of social support. Practitioners should consider individual- and city-level factors when devising effective interventions.

Classroom Size and the Prevalence of Bullying and Victimization: Testing Three Explanations for the Negative Association

Classroom size - i.e., the number of students in the class - is a feature of the classroom environment often found to be negatively related to bullying or victimization. This study examines three possible explanations for this negative association: (a) it is due to measurement effects and therefore only found for peer-reports (Hypothesis 1), (b) bullying perpetrators are more popular and have more friends in smaller classrooms (Hypothesis 2), (c) targets of bullying are more popular and have more friends in larger classrooms (Hypothesis 3). Multilevel regression analyses were conducted on a sample from Austria (1,451 students; Mage = 12.31; 77 classes) and a sample from the Netherlands (1,460 students; Mage = 11.06; 59 classes). Results showed that classroom size was negatively associated with peer-reported bullying and victimization in both samples, and with self-reported bullying and victimization in the Dutch sample only, suggesting partial support for Hypothesis 1. Students high in bullying were found to be more popular in smaller than in larger classrooms in the Austrian sample. The negative link between victimization and popularity was found to be stronger in smaller classrooms than in larger classrooms in the Dutch sample. However, classroom size was not found to moderate links between bullying or victimization and friendship in either sample. Hypotheses 2 and 3 were supported, but only for popularity and in a single sample. Further research is needed to better understand the higher prevalence of bullying found in smaller classrooms in many studies.

Long-acting reversible contraceptive utilization after policy change increasing device reimbursement to wholesale acquisition cost in Louisiana

BACKGROUND

Unintended pregnancies, occurring in nearly 1 out of every 2 (45%) pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives, namely intrauterine devices and implants. Inadequate reimbursement for long-acting reversible contraceptive devices may be an access barrier to long-acting reversible contraceptive uptake. In 2014, the Louisiana Department of Health Bureau of Health Services Financing implemented a policy change that increased the Medicaid reimbursement rates for acquiring long-acting reversible contraceptive devices to the wholesale acquisition cost.

OBJECTIVE

To examine the association of a Medicaid policy change that increased the long-acting reversible contraceptive device reimbursement rate to the wholesale acquisition cost (ie, price set by the manufacturers) on long-acting reversible contraceptive uptake among women at risk for unintended pregnancy.

MATERIALS AND METHODS

This retrospective, repeated cross-sectional study used 2013-2015 Louisiana Medicaid claims data and contraceptive provision measures to assess associations between patient (age, race, urban/rural residence, postpartum status) and provider (urban/rural location, specialty) characteristics and long-acting reversible contraceptive uptake among contraceptive users (N = 193,623) using bivariate and logistic regression analyses.

RESULTS

After long-acting reversible contraceptive reimbursement increased, there was a 2-fold likelihood increase in use in 2015 vs 2013 (odds ratio, 2.08; 95% confidence interval, 1.69-2.55). Long-acting reversible contraceptive uptake was more likely across all patient and provider subgroups in 2015 vs 2013 but notably among patients receiving contraceptive care from family planning clinics (odds ratio, 3.93; 95% confidence interval, 2.34-6.62).

CONCLUSION

Removal of a provider-level financial barrier to long-acting reversible contraceptive provision was associated with increased long-acting reversible contraceptive uptake among women at risk for unintended pregnancy. Efforts to improve long-acting reversible contraceptive access should focus on equitable healthcare reimbursement for healthcare providers of reproductive-aged women.

Evaluation of the smoking intervention X:IT after the second year: A randomized controlled trial

Aims:Review studies on the long-term effects of school-based smoking interventions show mixed results. X:IT was a three-year cluster randomized controlled trial to prevent uptake of smoking among Danish students from age 13 years until age 15 years which previously proved effective in preventing smoking after the first year of intervention. The aim of this paper was to conduct the pre-planned analyses of the effects of the X:IT intervention on smoking after the second year. Methods: We used self-reported questionnaire data from students at baseline, first, second, and third follow-up (n at second follow-up=3269, response rate=79.4%). Data from third follow-up were not suitable for analysis. Outcome measure: 'current smoking', dichotomised into smoke daily, weekly, monthly or more seldom versus do not smoke. We performed multilevel, logistic regression analyses of available cases and intention-to-treat (ITT) analyses, replacing missing outcome values by multiple imputation. Results: The prevalence of smoking increased from 5.8% at baseline to 17.0% at second follow-up among students at intervention schools, and from 7.6% to 18.7% among students at control schools. Analyses of available cases and ITT analyses did not support X:IT being effective in preventing smoking after the second year of intervention. Conclusions: Although X:IT was effective after the first year of intervention, we were not able to demonstrate any effects after the second year. Implementation of the intervention was lower in the second year compared to the first year which indicates that the missing effect of the intervention at second follow-up is due to lack of implementation.

Dental hygienist attendance and its covariates in an ageing Swedish cohort

Delegation of tasks between professional groups is important to make health-care services accessible and effective for ageing people. Focussing on a Swedish 1942 birth cohort and guided by Andersen's Behavioral Model, this study assessed dental hygienist attendance from age 50 to age 70 and identified covariates at the population-averaged and person-specific levels. In 1992, a census of 50-yr-old subjects was invited to participate in a questionnaire survey. Of the 6,346 respondents, 3,585 completed follow-ups in 1997, 2002, 2007, and 2012. Multiple logistic regression analysis was conducted using a marginal model and a random intercept model. Cochran's Q test revealed that significantly more respondents confirmed dental hygienist attendance in 2012 than in 1992 (57.2% in 2012 vs. 26.0% in 1992). Population-averaged ORs for dental hygienist attendance across time were 3.5 at age 70 yr compared with age 50 yr (baseline); 2.0 if being a regular rather than an irregular dental attendee; and 0.7 if being of non-native origin compared with native origin. The corresponding person-specific ORs were 8.9, 3.2, and 0.5. Consistent with Andersen's Behavioral Model, predisposing, enabling, and need-related factors were associated with dental hygienist attendance at population-averaged and person-specific levels. This has implications for promoting dental hygienist attendance among ageing people.

Using Biological Insight and Pragmatism When Thinking about Pseudoreplication

Pseudoreplication is controversial across experimental biology. Researchers in the same field can disagree on whether a given study suffers from pseudoreplication and on to what extent any pseudoreplication undermines the value of a study. A recent survey indicated that concerns about pseudoreplication can strongly impact peer review of manuscripts submitted for publication. Here we explore controversies around pseudoreplication, identify issues requiring resolution, and in each case offer a resolution. We emphasise that having non-independence in data points and pseudoreplicating are not the same thing. Researchers should be able to demonstrate that in a given experiment they have minimised and controlled the risk of non-independence weakening their study. If they do that to the satisfaction of others, they have avoided pseudoreplication.

Reasons for Inconsistent Condom Use Found as Answers to a Multiple Response Question: A National Survey of Iranian Adults, 2013

Background: The use of condoms is important for preventing Sexually Transmitted Infections (STIs). However, the prevalence of condom use is not satisfactory. The aim of this study was to assess the reasons for inconsistent condom use in Iranian adults.

Study design: Cross-sectional study.

Methods: Data were gathered through multi-stage sampling. Participants were enrolled from 13 provinces in Iran aged between 19 and 29 years. They had ever-extramarital sex and did not use condoms regularly in their sexual contacts, asked the reasons for inconsistent condom use.

Results: We had 3,246 adults, from which 635 (19.5%) had ever-extramarital sex. Among them, 495 (77.96%) did not use condoms with regularity. The reason frequently chosen for inconsistent condom use was ‘that it is not accessible’ (49.3%). The differences between the categories of some variables, according to the choice of reasons for inconsistent condom use, were significant (P<0.05): age, gender, knowledge of HIV, attitude towards HIV, knowing infected HIV person and alcohol or stimulant(s) used before sexual contact. According to multivariate multilevel logistic, the effect of gender was significant on most of reasons for inconsistent condom use (P<0.05).

Conclusions: Most of the reasons that were selected for inconsistent condom use were inaccessibility and not knowing that its use is essential. Hence, it is important to improve the knowledge of adults regarding STI/HIV and extend the locations of condom distribution. We should try to promote the culture of condom use as a routine.

Income inequality and fear of crime across the European region

This paper aims to take a holistic approach to studying fear of crime by testing predictors at multiple levels of analyses. Data from the European Social Survey (N = 56,752 from 29 countries) were used to test and extend the Income Inequality and Sense of Vulnerability Hypotheses. The findings confirm that (1) individuals in societies with greater income inequalities are more fearful of crime, and (2) older or disabled people as well as women report greater fear of crime. Contrary to the hypotheses, ethnic majority and not ethnic minority members report greater fear of crime, if they reside in high income inequality countries. It is further demonstrated that fear of crime explains the inverse association between income inequality and subjective well-being in this particular subsample.

Psychosocial work environment in school and students' somatic health complaints: An analysis of buffering resources

AIM

This study explores the association between the psychosocial work environment in school and students' somatic health complaints. With its point of departure from the Demand-Control-Support (DCS) model, the aim was to examine how aspects of decision control and social support can moderate stress-related health implications of high psychological demands.

METHODS

Data come from two cross-sectional waves of the Swedish version of Health Behaviour in School-aged Children (HBSC 2005/2006 and 2009/2010), which consists of a total of 9427 11-, 13- and 15-year-old students. A two-level random intercept model was applied, with school class as the level 2 unit.

RESULTS

Findings showed significant associations between school demands and somatic health complaints for all studied age groups, with a slight increase in strength with age. Decision control as well as social support from teachers, parents and peers consistently predicted a favorable association with health. An age pattern emerged in the analyses of stress-moderating resources. For 11 year olds parental support was the only resource that displayed a significant interaction with demands in relation to somatic health complaints, whereas for 13 year olds, decision control and support from teachers and parents all demonstrated moderating effects on student health. For 15 year olds, however, it was peer support that acted as a buffering resource in the studied relationship.

CONCLUSIONS

The psychosocial work environment is an important predictor of students' health complaints. Overall, social support was a better stress-moderating resource than decision control, but some "buffers" were more important at certain ages than others.

The relationship between teacher burnout and student motivation

BACKGROUND

Teacher burnout is regarded as a serious problem in school settings. To date, studies on teachers' stress and burnout have largely centred on teachers' own characteristics, socialization, and behaviours, but few have explored the connection between teachers' burnout and students' motivation via their own perceptions of teachers' behaviour and emotional well-being.

AIMS

This study adopted Maslach et al.'s (2001, Annu. Rev. Psychol., 52, 397) job burnout construct and self-determination theory to investigate the relationships between teachers' burnout and students' autonomous motivation over one-semester physical education classes.

SAMPLE

A total of 1,302 high school students and their 33 physical education teachers in 20 high schools from two school districts in a major Midwest metropolitan area in the United States. The two school districts were demographically similar.

METHODS

Students and physical education teachers completed questionnaires assessing relevant psychological constructs. There were two time points for collecting students' data. One was at the beginning of a fall semester, and the other was at the end of that semester. Hierarchical linear modelling analyses were conducted.

RESULTS

It was revealed that teachers' emotional exhaustion was negatively related to students' perceived teacher autonomy support (TAS); in turn, there was a negative relationship between teachers' feeling of depersonalization and students' autonomous motivation development even when controlling for inadequate TAS.

CONCLUSION

The dimensions of teachers' burnout might play different roles in the transmission from teachers to students. Teachers' status of burnout is an important environmental factor associated with students' quality of motivation.

What's so different about big data? A primer for clinicians trained to think epidemiologically

The Big Data movement in computer science has brought dramatic changes in what counts as data, how those data are analyzed, and what can be done with those data. Although increasingly pervasive in the business world, it has only recently begun to influence clinical research and practice. As Big Data draws from different intellectual traditions than clinical epidemiology, the ideas may be less familiar to practicing clinicians. There is an increasing role of Big Data in health care, and it has tremendous potential. This Demystifying Data Seminar identifies four main strands in Big Data relevant to health care. The first is the inclusion of many new kinds of data elements into clinical research and operations, in a volume not previously routinely used. Second, Big Data asks different kinds of questions of data and emphasizes the usefulness of analyses that are explicitly associational but not causal. Third, Big Data brings new analytic approaches to bear on these questions. And fourth, Big Data embodies a new set of aspirations for a breaking down of distinctions between research data and operational data and their merging into a continuously learning health system.

[Gender, age, occupation, economic sector and mental health in the workplace: the results of the study SALVEO]

OBJECTIVES

This article examined the contribution of gender, age, occupation and economic sector on psychological distress, depression and burnout.

METHODS

The data came from the SALVEO study carried out in 2009- 2012 among 2,162 workers employed in 63 Canadian workplaces. Multilevel logistic regression models were estimated on the total sample and separately for men and women.

RESULTS

The prevalences of psychological distress, depression and burnout were 23.8%, 5.8% and 3.9% respectively. Mental health problems varied between workplaces, but variations between workplaces were stronger for burnout. Differences between men and women were significant only for psychological distress, depression, and emotional exhaustion. Unskilled workers were found more at risk for depression and burnout. Associations among age, occupation and economic sector were not the same between genders.

CONCLUSION

Results from the SALVEO study highlight important mental health problems in workers that vary between workplaces, and that differences in symptomatology are associated with gender, age, occupation and economic sector. Gender reveals differentiated profiles of relationships. These results point towards the development of targeted approaches to the prevention of and intervention on mental health problems in workplaces.

Onset of work restriction in employed adults with lower limb joint pain: individual factors and area-level socioeconomic conditions

PURPOSE

To examine individual and area-level socioeconomic factors that predict the onset of work restriction in employed persons with lower limb joint pain.

METHODS

Population-based prospective cohort study. Adults were aged 50-59, reported hip, knee, foot pain or a combination and maintained employment through 3 year follow-up (n = 716). Work restriction was measured as inability to participate in work as desired. Multi-level logistic regression was used to assess the associations of work restriction onset with baseline factors: health (severity of knee pain/functional limitation, comorbidity, anxiety, depression, cognitive impairment, abnormal weight), demographic socio-economic, environment and area-level employment deprivation.

RESULTS

108 (15.1 %) reported the onset of work restriction over 3 years. Severe lower limb joint pain and functional limitation, number of affected body sites and area employment deprivation were independently associated with onset. Significant interactions indicated a greater effect of area employment deprivation on older and more depressed workers.

CONCLUSIONS

Results suggest that effectively preventing work disability in those with OA will require both condition-specific interventions to decrease pain and maintain function, and providing alternative employment opportunities for those with progressive functional limitations. Results in older workers are particularly concerning, as retirement ages are expected to increase in the general population.

The association between school class composition and suicidal ideation in late adolescence: Findings from the Young-HUNT 3 study

BACKGROUND

Few studies have explored the association between social context and suicidal ideation using multilevel models. This study examines how suicidal ideation in adolescence is related to school class composition.

METHODS

Data were obtained from the Young-HUNT 3 study (2006-2008), a population study of adolescents attending secondary school in the Norwegian county of Nord-Trøndelag. The final sample included 2923 adolescents distributed among 379 school classes in 13 schools. Multilevel logistic regression was used to estimate the contribution of various factors at the individual and school class levels.

RESULTS

The results indicate that 5.3 percent of the variation in suicidal ideation can be attributed to differences between school classes. However, a substantial part of this variation can be explained by an unequal distribution of students at risk as a result of individual factors. After controlling for individual-level variables, the results show a higher probability of suicidal ideation in school classes having higher proportions of girls as well as in those following a vocational education programme.

CONCLUSION

Targeting classes that either follow a vocational education programme or have a high proportion of girls can be an effective approach to intervention because such classes may include a greater number of students at risk for having suicidal thoughts compared to classes with a high proportion of boys or classes following a general education programme.

Family structure and posttraumatic stress reactions: a longitudinal study using multilevel analyses

BACKGROUND

There is limited research on the relevance of family structures to the development and maintenance of posttraumatic stress following disasters. We longitudinally studied the effects of marital and parental statuses on posttraumatic stress reactions after the 2004 Southeast Asian tsunami and whether persons in the same households had more shared stress reactions than others.

METHOD

The study included a tourist population of 641 Norwegian adult citizens, many of them from families with children. We measured posttraumatic stress symptoms with the Impact of Event Scale-Revised at 6 months and 2 years post-disaster. Analyses included multilevel methods with mixed effects models.

RESULTS

Results showed that neither marital nor parental status was significantly related to posttraumatic stress. At both assessments, adults living in the same household reported levels of posttraumatic stress that were more similar to one another than adults who were not living together. Between households, disaster experiences were closely related to the variance in posttraumatic stress symptom levels at both assessments. Within households, however, disaster experiences were less related to the variance in symptom level at 2 years than at 6 months.

CONCLUSIONS

These results indicate that adult household members may influence one another's posttraumatic stress reactions as well as their interpretations of the disaster experiences over time. Our findings suggest that multilevel methods may provide important information about family processes after disasters.

Community violence and urban childhood asthma: a multilevel analysis

We examined the association between community violence exposure and childhood asthma risk in a multilevel, multimethod, longitudinal study controlling for individual- and neighbourhood-level confounders and pathway variables. Analyses included 2,071 children aged 0-9 yrs at enrolment from the Project on Human Development in Chicago Neighborhoods. Multilevel logistic regression models estimated the likelihood of asthma, controlling for individual-level (child's age, sex, race/ethnicity, maternal asthma, socioeconomic status and family violence in the home) and neighbourhood-level confounders (concentrated disadvantage, collective efficacy and social disorder), and pathway variables (maternal smoking, breastfeeding). In adjusted analyses, medium (OR 1.60, 95% CI 1.17-2.19) and high levels (OR 1.56, 95% CI 1.12-2.18) of community violence were associated with increased asthma risk, relative to low levels. The increased asthma risk remained for African Americans when models included community violence and all other individual-level covariates, but attenuated to borderline nonsignificance when further adjusting for collective efficacy. Community violence is associated with asthma risk when controlling for individual- and neighborhood-level confounders. Neither community violence, nor the other individual-level factors, fully accounted for the excess asthma burden among African Americans. These data suggest that public health interventions outside the biomedical model may be needed to reduce asthma in disadvantaged populations.

Socioeconomic status at birth is associated with risk of schizophrenia: population-based multilevel study

BACKGROUND

Inconsistent findings obscure understanding the relationship between socioeconomic status (SES) and schizophrenia. The aim of the current study was to test the association between individual and community SES at birth and risk of schizophrenia.

METHOD

Population-based longitudinal follow forward study of a 13-year birth cohort (n = 71 165). Effects of individual and community socioeconomic variables were examined using multilevel regression in MLwiN.

RESULTS

Years of education of fathers and mothers, respectively, (0-8 vs 13+ odds ratio [OR] = 1.17, P < .0001; OR = 1.14, P < .001) lower occupational status of fathers (OR = 1.29, P = .036), and poorer residential area SES (OR = 1.26, P = .012) were risk factors for schizophrenia.

CONCLUSIONS

Individual- and community-level SES at the time of birth are associated with an increased risk of schizophrenia.